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Confirmation of Registration
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Confirmation of Registration
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| RE: SAMPLE |
| ________________________________ |
| The above applicant for registration has stated that he/she has been or is a member of your Association/Ordre/State Board and has granted permission to APEGGA to obtain additional information from sources it may deem necessary to the progression of the application. Please complete the applicable items below and return this form to us by mail or fax, as soon as possible. Thank you for your help. Sincerely Mark Tokarik, LL.B, P.Eng., Director Registration. |
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Registration was first granted as a |
 (Specify type of member or licensee) |
on
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(y/m/d) |
| Application for Professional Member Received on |
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| Application for Member-In-Training Received on |
y/m/d |
Date of Enrollment |
(y/m/d) |
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Membership was resigned or lapsed (if applicable) from |
 to(y/m/d) |
(y/m/d) |
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Annual dues are/were paid up until... |
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(y/m/d) |
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| Registration was granted on the basis of (1 + 2 + 3) or 4: | ||||
| 1) Having met the academic requirements as follows: | ||||
| a) | Acceptable bachelor degree |  |
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| b) | Unaccredited degree plus North American post-graduate degree (please specify degree and discipline) | |
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| c) | Examination program (please provide subjects/grades) | |
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| d) | Unaccredited degree plus Confirmatory Examinations (please provide subjects/grades) | |
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| e) | Experience in lieu of examinations | |
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| Was
confirmation of academic background received directly from the academic
institutions? If no, what was the source of the information/documentation? |
YesNo |
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| Please attach a copy of the member's transcripts. Copy of transcript attached? | YesNo |
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| and | ||||
| 2) | Having
met the experience requirement of  years
of acceptable experience |
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| and | ||||
| 3) | Having passed the Professional Practice Examination | |
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| or | ||||
| 4) | By Mutual Recognition through: | |||
| a) | Agreement on Mobility of Professional Geoscientists Within Canada | |
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| b) | Prior registration in/transfer from/comity with | |
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| and | ||||
| Having passed the Professional Practice Examination (if applicable) | |
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| Has this individual ever been subjected to any discipliary action? | Yes
No |
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| Please add any additional information relevant to the application, etc. | ||||
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| Signature | Position | Date | ||
| Revised: July 2001 | ||||